April 12, 2021

Change Ideas to Grow, Nurture, and Lift Ideas

(CIGNAL)

for Perinatal Mental and Behavioral Health

Agenda

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Housekeeping Lisa HongHealthy Start TA & Support Center

Welcome Kenn HarrisHealthy Start TA & Support Center

Introduction from the Division of Healthy Start and Perinatal Services

Dawn Levinson, DHSPS

Overview: Challenges around Perinatal Mental and Behavioral Health

Fleda Mask Jackson, MAJAICA

Main Challenges Connected to Healthy Start Kenn Harris

Case Studies: How Some Healthy Start Sites Are Supporting Perinatal Mental and Behavioral Health

Danette McLaurin Glass, Atlanta HSLisa Matthews, Moms First HS

Main Strategies for Healthy Start Kenn Harris

Potential Partnerships & Resources Wendy Davis, Postpartum Support InternationalKay Matthews, Shades of Blue

America Paredes, Mental Health America

Next Steps: Themes & Ideas to Explore in the Future Kenn Harris

Closing Kenn Harris

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Welcome & Introduction

Kenn Harris

Healthy Start TA & Support Center

CIGNAL for Perinatal Mental and Behavioral Health Project Goal:

Enhance and strengthen the capacity of HS grantees to identify and execute strategies to

promote mental and behavioral health among the women, infants, fathers, and families they serve

during and beyond the COVID-19 pandemic.

CIGNAL Project: Part 1Expert Meeting

• Identify and explore potential change ideas

• Describe issues and challenges

• Brainstorm strategies that HS programs can use to intervene at specific points along the continuum of care during and beyond COVID-19

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February 16

CIGNAL Meeting Experts

Danette McLaurin Glass

First TEAM America

Charlotte, NC

Dawn Levinson

HRSA/MCHB

Rockville, MD

Kay Matthews

Shades of Blue

Houston, TX

Fleda Mask Jackson

MAJAICA, LLC

Atlanta, GA

Wendy Davis

Postpartum Support

International

Portland, OR

Billie Jo Kipp

Center for Native American

Youth at the Aspen Institute

Washington, DC

CIGNAL Project: Part 2Healthy Start Grantee Webinar

• Review current challenges

• Highlight stories from HS grantees

• Identify potential strategies and change ideas

• Provide resources and tools

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Introduction from the

Division of Healthy Start and Perinatal Services

Dawn Levinson, MSW

Division of Healthy Start and Perinatal Services

Overview: Challenges Around Perinatal Mental & Behavioral Health

Fleda Mask Jackson, PhD

MAJAICA, LLC

F L E D A M A S K J A C K S O N . M . S . , P H . D .

M A J A I C A , L L C

A P R I L 1 2 , 2 0 2 1

Challenges around Perinatal Mental Health

Background

30% of Black expectant mothers show signs of depressive symptoms; up to 40% of Black women will suffer from postpartum depression

14-30% maternal suicide and drug overdose

Increased stress, exposure to trauma, financial barrier, lack of paid leave and dangerous working condition, pregnancy complications and higher pregnancy complications

Key Issues

Mental health care as auxiliary to physical health care; lack of integrated care for expectant, birthing and postpartum mothers

Lack of universal perinatal mental health screening; progress but not universally assessed

Need for screening to assess the particular contextualized risks for adverse poor mental and behavioral health during pregnancy.

Key Issues

Inequities for community based treatment for prenatal and postpartum mental health care

Need for diverse maternal mental health providers

Essential training for addressing the needs of pregnant WOC regardless of the background of the provider

Misdiagnosis

Key Issues

Lingering beliefs (disbeliefs) about mental health and WOC

Stigma and Shame (weakness, crazy and abnormal, some other group’s ailment)

Lacks of information and knowledge

The spectra of suicide

Addiction

Opportunities

National Focus on Mental Health and Covid-19

Elevated focus on U.S. maternal mortality rates; Birth Equity for Black expectant, birthing and postpartum mothers

Telemedicine

Innovation: community health workers and home visitors

Advocacy

Main Challenges Connected to Healthy Start

Kenn Harris

Healthy Start TA & Support Center

Impact of historical trauma on communities of color.

Key Challenge # 1

Widespread lack of informed, respectful, and culturally-

responsive care

Key Challenge # 2

Fragmentation in the mental health services system forces people to rely

on health care workers to pull various services together

Key Challenge # 3

Stigma and the lack of a shared language prevents people from

identifying mental health issues and promoting wellness within

themselves and their community

Key Challenge # 4

Traditional MCH services focus solely on the mother and child and there is a lack of inclusion of the entire family

and broader community,

Key Challenge # 5

Case Studies:

How Some Healthy Start Sites Are Supporting Perinatal Mental and

Behavioral Health

Danette McLaurin Glass, Atlanta HS

Lisa Matthews, Moms First HS

Mom’s Voices Are Critical:

Valuing the Consumer's Voice in Care, Research and Advocacy for Maternal Mental Health Disparities

Presented by: Danette McLaurin Glass, Senior Strategist, First TEAM America

“If you want to go quickly, go alone. If you want to go far, go together.” – African Proverb

This presentation is a snapshot of how limited research of perinatal mental health results in insufficient data for evidence-informed MMH care.

To achieve the best MMH equity outcomes for mothers; culturally and contextually responsive interventions responding to a woman’s lived experiences is vital.

Introduction

1) Establish a research, promotion and advocacy plan to

address disparities, service delivery, biases and stigma

with consumers/community partners.

2) Understand the vital role of Healthy Start Family

Support Workers (Community Health Workers, Resource

Moms, etc.) with identifying PMADS.

3) Provide opportunities for consumers to advocate to

care providers, legislatures and state agencies on the need

for extensive perinatal mental health services.

OpportunitiesandObjectives

Our Journey

Why Maternal Mental Health ?

Our CAN

The CBPR Approach

Onward

CBWW

• Community based non-profit health center with 30+ year history

• Serves women and families in Metro Atlanta, with special attention to NPU-V

• Provides holistic care, focused on physical, mental, and economic well-being

Drivers

Vestibulum congue

Outcomes

About Us

Natalie D. Hernandez, PhD, MPHAssistant Professor, Department of Community Health and Preventive MedicineMorehouse School of MedicineSocial and Behavioral ScientistResearch Interests: CBPR, Social Determinants of Health, Maternal and Child Health, Health Policy

Danette McLaurin Glass, Senior StrategistFirst TEAM America, LLC Strategic Partnerships and Infrastructure Development ConsultantsFacilitator and Coordinator, AHSI- Community Action Network of the Center for Black Women’s Wellness, Inc.Regional Board President, The Center for Family and Community Wellness , Inc.Advocacy Interests: Maternal Mental Wellness, ACES, Child Welfare, Justice Reform, Family Wellness, Health Disparities, Trauma Responsive Communities and Governments

Why Maternal Mental Health

Maternal Mental Health Disparities

Black women and women of color more generally, have a much

higher risk of developing PMAD

Black women are screened for PMADS at lower rates

Common screening tools used to assess PMADS may not accurately

assess symptoms in women of color

60% of women of color do not receive proper treatment or

support for perinatal emotional concerns

Purpose

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To assess the mental/emotional health challenges of underserved women in Atlanta

To examine local priorities and sources of care for mental health among underserved women in Atlanta

Understanding What Impacts Mom

Research Studies / Info

No baseline Data

Sparse Research

Understood correlation between stress, MMH, Depression, Poor birth outcomes

Jackson-Hogue Scale

Challenges

Stress Factors

A Mother’s Cry

Community Partners, Community Health Workers and Family Members provided their input from observations, interactions and assessments:

● Agitation

● Depression

● Anger

● PMADS

Please note: The Edinburgh screening is performed for all HS participants.

Listening to understand ...

The Value of a Mother’s Voice

PICTURE

How we value voice

Perinatal Mood

and Anxiety Disorders (PMADs)

Atlanta Healthy Start Initiative (AHSI)

Community

Community Action Network

Group

Peer support and group education

Individual

Evidence-based home visiting

Community Action Network (CAN)

Community Action NetworkYes We CAN!

• Collective Impact Framework

• Common Agenda

• Established Workgroups

• Strong Backbone Support

• Over 200 community members representing families, agencies, public and private entities.

Collective Impact Framework

○ Common Agenda

○ Established Workgroups

○ Strong Backbone Support

○ Continuous Communication

○ Mutually Reinforcing Activities

○ Over 200 community members

representing families, agencies,

public and private entities

2017-2019 AHSI - CAN Strategy

Health Promotion

Community Engagement

Education/ Training

Community Awareness

Topic Prioritization

Community Action Network

Identified 3 Focus Areas

Breastfeeding

Early Learning Literacy / Early Brain Development

Maternal Mental Health

Workgroups

Community Action Network

After 3 years... Maternal Mental Health

became the CAN’s “Common agenda”

Community Based Participatory Research

Because its a partnership approach to

research, and...

● Equitably involves all partners in all aspects of

research

● Enables all partners to contribute their expertise,

with shared responsibility and ownership

● Enhances understanding of a given phenomenon

● Integrates the knowledge gained with

interventions

Why CBPR

?

Unethical Research Practices

Traditional Research

Distrust Ineffective interventions

Individual Focused

Benefits of

CBPR Approach

● Provides resources for communities involved

● Joins partners with diverse expertise to address complex public health problems

● Increases trust and bridges cultural gaps between partners

● Has potential to translate research findings to guide development of interventions and policy change

Pilot: Integrating Perinatal Mental Health Services in Community-Based

Settings

• Funded through Detroit Community-Academic Urban Research Center, University of Michigan School of Public Health (federal flow-thru)

• Mixed Methods

– Collective Impact Framework

– Topic identified as a priority by community

Ethical Concerns

Expressed by

Stakeholders

● Community consent

● Fetal safety

● Maternal risk

● Informed consent

● Information sharing and community re-engagement

Outcomes

CBPR BMMH Project Documents

Survey Administration Activities

Promoting Local Systems Change

Black Mamas Matter Alliance

Maternal Mortality Review Action Committee

Maternal Health Stakeholder Group

Post Partum Support International-GA Chapter

Advocacy Committee

Georgia Perinatal Quality Collaborative

March of Dimes Maternal and Child Health Committee

Black Mother Breastfeeding Association

Mental Health Advisory Council

Preliminary Data -

Quantitative

● 63% of the participants (n=39) self-reported they had a maternal mental health concern.

● Reasons cited for lack of comfort talking to a health care provider:● not being asked (34%)● feeling embarrassed or

ashamed (20%)● concerned about it

being noted in medical records (25%)

Next Steps● Data Collection

● Dissemination

● Diversified Strategy

● CityMatCH, Journal Article, Webinars, Bioethics Conference, HeLa Conference, GEERS Tour Bus

● Sustainability efforts

● New partners

● Grant Proposals

Special Acknowledgementsfor your consistent

support of the BMMH-CBPR Project

The Atlanta Healthy Start Initiative Community Action Network, Morehouse School of Medicine, Center for Black Women’s Wellness, The Center for Family and Community Wellness and the Atlanta Healthy Start Initiative, Healthy Mothers-Healthy Babies Coalition of Georgia, Odyssey Family Counseling Center, Emory University, Mental Health America of Georgia, Prevent Child Abuse, Georgia Department of Public Health, WELLCARE, Amerigroup, Sheltering Arms, Atlanta Public Schools, GA Society of OBGYN, First TEAM America

Key Factors● Identify strong community partners

● Build or strengthen community coalition for engagement

● Identify a common agenda

● Strong backbone support for effective project execution

● Conduct a formal or informal community needs assessment

● Include community in every aspect of planning, training and execution of research

● Celebrate milestones along the way

● Continue to listen to community shifts and adjust accordingly

For More Information:

Danette McLaurin Glass, CAN Facilitator / ConsultantAtlanta Healthy Start Initiative - Community Action Network Atl.healthy.start@gmail.com678-613-7716

Natalie Hernandez, PhD, MPH, Co-PIAssistant Professor , Morehouse School of Medicinenhernandez@msm.edu

MomsFirst Virtual Platforms

▪ In September 2020 MomsFirst launched Moms Clubs and Fatherhood Talks to enhance virtual services provided to participants and promote behavioral and mental health among mothers, fathers and families served.

▪ In addition to providing education and resources on topics such as preterm labor, breastfeeding, family planning, etc. the goal was to build peer-to-peer support among each group of participants as well as improve connection for new participants to the program and their CHW.

▪ 24 Curriculum Activities

▪ Bilingual handouts

▪ Helps home visitors and health

educators teach important

prenatal health information

▪ Teaches health literacy skills in

a pregnancy context

▪ Can be used for group or

individual education

Baby Basics Tools:

Moms Club Curriculum

Moms Club Facilitation

▪ Moms Clubs are held weekly and facilitated by Community Health Workers.

▪ Moms are recruited and grouped by due date to participate in monthly

sessions.

▪ Example: In the month of March, the first week’s session includes Moms

due in March; the second week, Moms due in April; the third week, Moms

due in May; and the 4th week, Moms due in June.

▪ Provide opportunities to openly discuss concerns with other women and an

intimate setting to provide dialogue.

▪ Incentives are provided.

▪ Beginning in February 2021 the Fatherhood Coordinator began attending

Moms Clubs to introduce the fatherhood program to attendees.

“I like being with

other women who

are pregnant

because it doesn’t

matter what your

background or

situation is, we are

all going through the

same things.”

Father Talk

▪ Father Talk sessions are held

twice/month.

▪ A recruitment session is held on the

second Tuesday of the month for

dads not enrolled in the MomsFirst

Fatherhood Program.

▪ On the fourth Thursday of the

month a session is held for enrolled

dads on various educational topics.

▪ Recruitment is done by CHWs and

the Fatherhood Coordinators.

▪ Sessions are held in the early

evening and incentives are

provided.

Father Talk

One of the unexpected positive

impacts we have witnessed is the

networking between participants.

Dads are exchanging phone

numbers and bartering with each

other to support one another with

the skill sets they possess.

Lisa Matthews, MBAMomsFirst Project Director

Cleveland Department of Public Health

75 Erieview Plaza

Cleveland Ohio 44114

(office) 216-664-4281

(fax) 216-664-2501

lmatthews@city.cleveland.oh.us

www.momsfirst.org

Main Strategies for

Healthy Start

Kenn Harris

Healthy Start TA & Support Center

Strategy 1: Address trauma throughout the perinatal continuum (before pregnancy and beyond)

Strategy 2: Create space for community members and community-based organizations to be at the table and drive interventions – without burdening communities – through Healthy Start CANs

Strategy 3: Create a centralized place to connect people to mental and behavioral health services and support

Strategy 4: Adopt community-based, culturally-supportive interventions (from the culture, by the culture)

Strategy 5: Recognize the role of spirituality in forming and sustaining relationships for communities of color

Strategy 6: Develop shared language around mental health to combat stigma and shift focus to wholeness and wellness

Potential Partnerships & ResourcesWendy Davis, PhD, PMH-C, Postpartum Support International

Kay Matthews, Shades of Blue

America Paredes, Mental Health America

Postpartum Support International

Postpartum Support International ©2021 47

PSI Support for

Families

Po

stpartu

m Su

pp

ort In

ternatio

nal ©

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➢ Toll-free Helpline 800-944-4PPD support to women and families in English & Spanish

➢ PSI Support Coordinator Networkhttp://www.postpartum.net/get-help/locations/

• Specialized Coordinators

➢ Online Support Groupswww.postpartum.net/get-help/psi-online-support-meetings/

➢ PSI Facebook Group -https://www.facebook.com/groups/25960478598/

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Specialized Support

Coordinators

● Postpartum Psychosis ● LGBTQIA+● Adoptive Parents● Birth Mothers ● Dads ● Grandparents ● Military Families ● Teen/Young Parents● Breast & Body-

Feeding● Insomnia● Parents of Multiples● Teen & Young Adults● Children with Special

Needs

● Feeding Complications● Hyperemesis Gravidarum

(HG)● Pregnancy/Infant Loss● NICU Parents ● Infertility● Maternal Near Miss

Survivors ● Substance Use● Muslim Families● Bed Rest● Post-Abortion● Spanish Support● Arabic Support

Postpartum Support International ©2021 49

Perinatal Mental Health Alliance for People of Color

A program within PSI

Vision: To provide a safe space for clients,families, and professionals of color aroundperinatal mental health. Every person of color will be heard and supported around perinatal emotional wellness.

https://www.pmhapoc.org/

https://www.facebook.com/pmhapoc/

Postpartum Support International ©2021 50

51Postpartum Support International ©2021

• PSI Educational DVDs -promo/trailer linkhttps://vimeo.com/ondemand/postpartumvideo

• PSI Public Service Announcements • 7 PSAs available to view or

download/share on Vimeo• www.postpartum.net/news-and-

blog/publicserviceannouncements/

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EDUCATIONAL VIDEOS

Postpartum Support International ©2021

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Postpartum Support International ©2021

Mental Health America

America Paredes

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• We work to change the laws that help people get mental health help when they need it.

• We teach people about mental health to help them understand that what they feel is normal.

• We go out into the community to talk about mental health so that we do not ignore the problem.

Who is Mental Health

America

• Half of all mental disorders begin by age 14 and three-quarters by age 24.

• These frequently go undiagnosed for up to ten years after symptoms emerge.

• Young adults aged 18-25 had the highest prevalence of any mental illness (AMI; at 26%) compared to other adults.

• Young adults are feeling the effects of the pandemic more deeply than any other age group – with greater levels of anxiety and depression.

No Health Without Mental Health

Awareness Education Community

We believe mental health is a part of overall wellness.

• Prevention

• Early identification and

intervention

• Integrated care,

services, and supports

• Recovery as the goal

MHA Screening Programwww.mhascreening.org

• It’s free for anyone to use

• It’s anonymous, which increases

the likelihood that people will

be honest

• People can play around vs take

it once in an office

• People can print, email, and

save results

• Learn more after screening

Get connected to others and

support

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Perinatal Mental Health Screen

• Started May 2020

• 13,641 Screens

• 81% Female, 17%

Male, 2% Other

• 85% scored

Depression is Probable

Perinatal Mental Health Care Access

Mental Health Education Campaigns

• May is Mental Health Month

• BIPOC Mental Health Month

• Back to School• Mental Illness Awareness

Week• Life on Campus• COVID 19 and Mental

Health

When should you talk to someone?

• When you start feeling like something is not quite right, you should talk to someone.

• Early warning signs:

• Problems with concentration, memory, or ability to think clearly

• Changes in eating, energy levels, and sleep patterns

• Loss of interest and withdrawal

• Sensitivity to sounds, sight, smell

• Feeling like your brain is playing tricks on you

MHA Resources

• Mental Health Month (e.g., fact sheets, social media content): www.mhanational.org/may

• Support tools (e.g., In the Open podcast, DIY tools, articles): www.mhascreening.org

• BIPOC Communities: www.mhanational.org/bipoc

• LGBTQ+ Communities: https://mhanational.org/issues/lgbtq-communities-and-mental-health

• Youth, Parents, and Families: https://mhanational.org/back-school

• College Students: https://mhanational.org/life-campus

Additional Resources• Warmlines

o Hours vary by location o http://www.mhanational.org/warmlines

• SAMHSA National Helplineo 1-800-662-4357 Available 24/7- 365 Spanish available o www.samhsa.gov/find-help/national-helpline

• SAMHSA National Disaster Distress Helpline o 1-800-985-5990 Available 24/7 – 365o www.disasterdistress.samhsa.gov

• National 211 o www.211.org

Contact Us Mental Health America500 Montgomery StreetSuite 820Alexandria, VA 22314

/mentalhealthamerica@mentalhealtham@mentalhealthamerica/mentalhealtham/mentalhealthamerica

America Paredes

aparedes@mhanational.org

Next Steps:

Themes & Ideas to Explore in the Future

Kenn Harris

Healthy Start TA & Support Center

Let’s Take a Pauseto Digest

What are your reactions to the ideas generated today?

What do you think about the change ideas and strategies we have discussed?

CIGNAL Summary Artifact

• TASC will take the ideas generated during the CIGNAL Expert Call and the discussion from this webinar and create a summary artifact

• Document will be shared with Healthy Start community

Request 1:1 TA

• Our Quality Improvement Advisor, Jane Taylor can provide 1:1 TA support to help your HS project further develop and test change idea strategies

• Visit the EPIC website to submit a TA request! • Click the “HS EPIC Center Tab”

and select “Request Technical Assistance”

MCHB’s Point of Contact for Behavioral Health Resources or Questions

• Dawn Levinson, MSW, the Division’s Mental and Behavioral Health Lead

• Email: dlevinson@hrsa.gov

• TASC is always here to support you as well!

Kenn HarrisHealthy Start TA &

Support Center

Closing

Questions?

Please email the Healthy Start TA & Support

Center at healthystart@nichq.org